Crunching Numbers, Saving Lives

The NEMSQA Measures

Nicolas Foss, Ed.D., MS

2025-10-20

Objectives

Today we will look at…

  • Reintroduce NEMSQA and its measures
  • Iowa NEMSQA measure performance 2021-2024
  • Discuss trends, geographic distribution
  • Takeaways given performance, considerations of data limitations

Accessing this presentation

QR Code for the slides to this presentation.

Statistics

  • All performance estimates are calculated as a percentage
  • 95% confidence intervals are shown beside each estimate in brackets []
  • Confidence intervals(CIs) help us infer what true performance might look like with more data
  • CIs say “If we repeat the same data collection again 1,000 times, 95% of the results would fall in this interval.”

NEMSQA, what?

  • National EMS Quality Alliance
    • In 2014, NHTSA funded the EMS Compass Project (led by NASEMSO) to develop and test EMS performance measures. Uptake was limited, but it established key groundwork.
    • NHTSA and HRSA later supported the creation of the National EMS Quality Alliance (NEMSQA), initially facilitated by the American College of Emergency Physicians.

NEMSQA, what?

NEMSQA is now an independent, non-governmental organization serving as the national steward for EMS quality measures.

The Iowa Department of Health and Human Services recognizes NEMSQA’s foundational role in shaping EMS quality assessment.

NEMSQA Measures

A key feature of NEMSQA has to do with the creation of quality measures that can be thought of as national standards vetted by the community of practitioners versus a government entity.

NEMSQA Measures

  • NEMSQA uses a structured, lifecycle-based process to develop and maintain EMS quality measures.
  • Process ensures measures evolve with:
    • New clinical evidence
    • Changing system capabilities
    • Emerging stakeholder needs

Achievements

Here, we will review:

  • Airway-18 (Waveform Capnography Use for Airway Confirmation)
  • Asthma-01 (Beta Agonist Administration for Asthma)
  • Hypoglycemia-01 (Treatment of Symptomatic Hypoglycemia)
  • Safety-01 (Non-Use of Lights and Sirens During Response)

Achievements

Here, we will review:

  • Safety-02 (Non-Use of Lights and Sirens During Transport)
  • Trauma-01 (Pain Assessment in Trauma Patients)
  • Trauma-03 (Pain Reduction Achieved)

Airway-18

This process measure tracks the use of waveform capnography for confirming and monitoring advanced airway placement.

A statistical table showing Iowa performance on the Airway-18 NEMSQA measure for the years 2021-2024.

Asthma-01

This process measure monitors the administration of aerosolized beta agonists during EMS responses for patients diagnosed with asthma.

A statistical table showing Iowa performance on the Asthma-01 NEMSQA measure for the years 2021-2024.

Hypoglycemia-01

This measure captures the percentage of patients with symptomatic hypoglycemia who receive corrective treatment.

A statistical table showing Iowa performance on the Hypoglycemia-01 NEMSQA measure for the years 2021-2024.

Safety-01

This measure captures the percentage of EMS responses where lights and sirens were not used during the initial response phase.

A statistical table showing Iowa performance on the Safety-01 NEMSQA measure for the years 2021-2024.

Safety-02

Like Safety-01, this measure focuses on the transport phase, documenting cases in which lights and sirens were not used.

A statistical table showing Iowa performance on the Safety-02 NEMSQA measure for the years 2021-2024.

Trauma-01

This measure evaluates whether a pain assessment was completed for patients with injuries.

A statistical table showing Iowa performance on the Trauma-01 NEMSQA measure for the years 2021-2024.

Trauma-03

An outcome measure that tracks whether a decrease in pain score occurred during EMS transport.

A statistical table showing Iowa performance on the Trauma-03 NEMSQA measure for the years 2021-2024.

Gaps

Here, we will review:

  • Airway-01 (First-Attempt Advanced Airway Success)
  • Airway-05 (Preoxygenation Prior to Intubation)
  • Pediatrics-03b (Documentation of Weight for Weight-Based Medications)
  • Respiratory-01 (Assessment of Respiratory Distress)
  • Respiratory-02 (Oxygen Administration for Hypoxia)

Gaps

…in addition:

  • Safety-04 (Pediatric Restraint Use During Transport)
  • Seizure-02 (Benzodiazepine Administration for Status Epilepticus)
  • Stroke-01 (Stroke Assessment in Suspected Stroke Patients)
  • Syncope-01 (ECG Performed for Syncope)

Gaps

…along with:

  • Trauma-04 (Transport to a Trauma Center)
  • Trauma-08 (Trauma Vital Signs Documentation)
  • Trauma-14 (Pre-Arrival Trauma Alerts)
  • TTR-01 (Vital Signs for Non-Transported Patients)
  • TBI-01 (Documentation of Key Physiological Parameters)

Airway-01

This outcome measure assesses the percentage of EMS responses initiated through a 911 call in which advanced airway placement was successful on the first attempt without documented episodes of hypotension or hypoxia during the peri-intubation period.

A statistical table showing Iowa performance on the Airway-01 NEMSQA measure for the years 2021-2024.

Airway-05

This process measure evaluates the proportion of intubation procedures in which adequate oxygenation was achieved prior to airway insertion.

A statistical table showing Iowa performance on the Airway-05 NEMSQA measure for the years 2021-2024.

Pediatrics-03b

This measure focuses on the documentation of either actual weight in kilograms or length-based weight estimates for pediatric patients who receive weight-based medications.

A statistical table showing Iowa performance on the Pediatrics-03b NEMSQA measure for the years 2021-2024.

Respiratory-01

This process measure evaluates whether EMS providers conducted a respiratory assessment for patients with a primary or secondary impression of respiratory distress.

A statistical table showing Iowa performance on the Respiratory-01 NEMSQA measure for the years 2021-2024.

Respiratory-02

This measure tracks oxygen administration for patients with documented hypoxia during EMS response.

A statistical table showing Iowa performance on the Respiratory-02 NEMSQA measure for the years 2021-2024.

Safety-04

This process measure tracks the use of appropriate pediatric restraint devices during EMS transport for patients under 8 years old.

A statistical table showing Iowa performance on the Safety-04 NEMSQA measure for the years 2021-2024.

Seizure-02

This process measure assesses the timely use of benzodiazepines in treating status epilepticus.

A statistical table showing Iowa performance on the Seizure-02 NEMSQA measure for the years 2021-2024.

Stroke-01

This measure ensures that stroke assessments are performed during EMS encounters when stroke is suspected.

A statistical table showing Iowa performance on the Stroke-01 NEMSQA measure for the years 2021-2024.

Syncope-01

This measure captures whether a 12-lead ECG was performed for patients presenting with syncope.

A statistical table showing Iowa performance on the Syncope-01 NEMSQA measure for the years 2021-2024.

TBI-01

This measure requires the documentation of oxygen level, end-tidal CO₂ (ETCO₂), and systolic blood pressure during EMS transport of patients with suspected traumatic brain injury.

A statistical table showing Iowa performance on the TBI-01 NEMSQA measure for the years 2021-2024.

Trauma-04

This process measure assesses whether patients meeting CDC trauma triage criteria were transported to an appropriate trauma center.

A statistical table showing Iowa performance on the Trauma-04 NEMSQA measure for the years 2021-2024.

Updated Trauma-04

Presently, NEMSQA is updating Trauma-04 to abandon using the eDisposition.23 field and instead leveraging eDisposition.01 or eDisposition.02 due to high variability in eDisposition.23.

Updated Trauma-04

A statistical table showing Iowa performance on the NEW Trauma-04 NEMSQA measure for the years 2021-2024.

Trauma-08

This measure evaluates whether the Glasgow Coma Scale (GCS), systolic blood pressure, and respiratory rate were documented in trauma patients.

A statistical table showing Iowa performance on the Airway-01 NEMSQA measure for the years 2021-2024.

Trauma-14

This measure tracks whether a pre-arrival trauma alert was activated for patients meeting field triage criteria (Steps 1 or 2).

A statistical table showing Iowa performance on the Trauma-14 NEMSQA measure for the years 2021-2024.

TTR-01

This process measure evaluates whether a basic set of vital signs was documented for patients not transported by EMS.

A statistical table showing Iowa performance on the TTR-01 NEMSQA measure for the years 2021-2024.

Takeaways

  • Demonstrates national leadership in operational safety practices
    • Significant reduction in lights and sirens use during both response and transport
  • Leads peer states in waveform capnography adoption

Takeaways

  • Excels in clinical care performance
    • Strong results in asthma treatment and hypoglycemia management
    • Slightly exceeds national averages in trauma pain assessment
  • Evidence of a strong commitment to quality improvement across agencies

Takeaways

  • Key gaps in clinical performance:
    • Airway management, trauma triage, stroke care, seizure treatment, syncope evaluation
    • Persistent pediatric care and documentation deficiencies

Takeaways

  • Data completeness and accuracy remain limiting factors for system improvement
    • Many EMS professionals record critical details only in narratives, not in discrete data fields
    • Transitioning from narrative-heavy to structured documentation is essential for valid performance measurement

Strategic Priorities

Iowa’s proven record of progress positions it well for future EMS quality gains

  • Expand clinical education and simulation-based training
  • Reinforce standardized EMS protocols statewide
  • Address pediatric care disparities directly

Strategic Priorities

Iowa’s proven record of progress positions it well for future EMS quality gains

  • Improve EMS data quality: transition from narrative-heavy documentation to structured, discrete data fields for accurate performance measurement
  • Modernize and strengthen EMS data infrastructure

Analyses

At BEMTS, we have been hard at work creating open source software that benefits Iowans and other jurisdictions.

{nemsqar} package page

QR Code for the traumar R statistical computing package GitHub repository.

Questions?

Thanks!

Nicolas Foss, Ed.D., MS

Epidemiologist

Bureau of Emergency Medical and Trauma Services

Bureau of Health Statistics

Division of Public Health > Iowa HHS

C: 515.985.9627 || E: nicolas.foss at hhs.iowa.gov